ENCOPRESIS

 Basic information

description

Encopresis is when a child regularly passes bowel movements (stools) into his or her underpants (or some other inappropriate place). The child is of an age (typically age 4 and over) when children can control their bowel movements. In most children, encopresis is involuntary. The child does not do it on purpose. It is more common in boys than girls.

FREQUENT SIGNS & SYMPTOMS

• Bowel movements in underwear. Sometimes the bowel movements may be on the floor or other places. They usually occur during daytime and rarely at night.
• Not able to control bowel movements.
• Passing large, hard stools that cause pain.
• Secretive behavior about bowel movements.
• Stomach pain or cramps.
• Odor due to stool in child's pants.

causes

• It is often a symptom of chronic constipation
  • Constipation is often caused by the passage of large, hard, and painful stools. To avoid the pain, a child avoids going to the toilet, which worsens the problem.
  • The longer the stool remains in the colon, the more difficult it is for the child to push out. When the colon becomes too full, soft or liquid stool can leak out.
  • Over time, the child no longer senses the normal urge to have a bowel movement. He or she may pass a bowel movement into the underwear and not be aware of it. They also become unaware of the odor.
• Emotional and developmental issues may be involved.
• In rare cases, a child may have been born with a physical disorder that leads to the problem.

risk increases with

• Boys more often than girls.
• Chronic constipation; painful or difficult stooling.
• Toilet training that may be harsh, too early, or lacking.
• Avoidance of school bathrooms.

PREVENTIVE MEASURES

• Try to prevent chronic constipation. Provide child with a healthy diet that includes fruits and vegetables. Be sure the child drinks plenty of fluids each day. Help the child to establish regular bowel habits.
• Get medical advice about toilet training your child.

expected outcomes

Usually curable once the constipation is controlled. Parents need to be patient. It may take several months for the problem to get better. Relapses may occur.

possible complications

Child may suffer from embarrassment, shame, guilt, and low self-esteem. Parents feel frustrated and angry.

 diagnosis & treatment

general measures

• Your child's health care provider will do a physical exam. Questions will be asked about the child's symptoms and other areas of the child's life. Medical tests may be done to check for illness or a physical problem.
• Treatment may involve a combination of medical measures and behavioral therapy. Each child is different and will respond to different treatment steps.
• Emptying the bowel is usually the first step. It may be done with enemas, suppositories, or oral laxatives.
• To help establish regular soft and pain-free bowel movements, daily laxatives are usually recommended. They help the child to pass soft stools without pain.
• Set regular times for going to the bathroom. The child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. This is done every day.
• Behavioral techniques may involve positive reinforcement by rewarding the child for developing regular toilet habits. Don't punish the child for accidents.
• During treatment, keep a record of the child's bowel movements, laxative use, and behavioral rewards. This will help determine what steps are successful.
• Other treatment options may include biofeedback and helping the child learn how to control the muscles and urges involved in bowel movements.

medications

• Your child's health care provider will discuss the options for enemas, suppositories, and the different types of laxatives recommended for your child.
• Ask your child's health care provider about treating infrequent constipation with stool softeners.

activity

Children should be physically active every day.

diet

Provide a healthy diet with fresh fruits and vegetables. Drinking plenty of fluids helps keep stools soft. In some cases, a diet high in fiber may be recommended.

 notify our office if

• Your child has symptoms of encopresis.
• Symptoms don't improve despite treatment.

Special Notes: